Healthcare Provider Details

I. General information

NPI: 1417934324
Provider Name (Legal Business Name): REBECCA LUCILLE A.P.R.N. PSYCHIATRIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANDERSON A.P.R.N. PSYCHIATRIC

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E SUITE 240
SALT LAKE CITY UT
84121-1720
US

IV. Provider business mailing address

337 N MAIN ST
SALT LAKE CITY UT
84103-1633
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7225
  • Fax: 201-263-7279
Mailing address:
  • Phone: 801-633-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number3423224405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: